t was 1980 and the patient in Dr. Glen Gabbard's
consulting room had a pressing request.

She had just seen "Ordinary People," she told him, and in the
movie, Judd Hirsch, who played the therapist, hugged Timothy Hutton,
who played the suicidal patient.

"It really helped him a lot," the woman said, "so I was wondering
if you could hug me."

Dr. Gabbard explained to the young woman that "Ordinary People"
was a movie.

"This is therapy," he said, "and we need to use words."

"Yes, I know it was a movie," the patient replied, "but the hug
helped a lot."

Where does the public get many of its ideas about psychiatry and
mental illness? From Hollywood, of course.

And Hollywood, said Dr. Gabbard, who has spent many years
examining the rendering of his field in the movie theater, has
mostly preferred distortion and stereotype over more true-to-life
representations.

Yet inaccurate as such portraits are, they are also
compelling.

"People don't make distinctions between what's reality and what's
on the great silver screen," Dr. Gabbard said.

At the Menninger Clinic in Topeka, Kan., where he trained as a
psychoanalyst and later became medical director, patients often
asked him to hypnotize them so they could recover repressed
memories.

Dr. Gabbard came by his passion for movies naturally: his parents
are professional actors. And after a while, psychoanalyzing
psychiatry's relationship with the motion pictures became a hobby,
eventually resulting in the 1987 book "Psychiatry and the Cinema,"
written with his brother, Dr. Krin Gabbard, a professor of
comparative literature at the State University of New York at Stony
Brook.

As an added perk, Dr. Gabbard noted, his sideline gave him "an
excuse to watch bad movies and call it part of my work."

"I can really get into bad movies," he added.

Yet very occasionally, he said, screenwriters and directors who
tackle the subject of mental disorders and their treatments get it
right.

In Dr. Gabbard's view, "The Sopranos" is the best depiction of
psychotherapy "ever to appear on film or television." (His new book,
"The Psychology of the Sopranos," is scheduled for publication by
Basic Books this summer.)

And "A Beautiful Mind," Ron Howard's award-winning drama
chronicling the genius and the battle with schizophrenia of the
mathematician John Forbes Nash Jr., who won the Nobel Prize for
economics in 1994, is as accurate a portrait of the illness as
Hollywood has produced.

Q. How has schizophrenia typically been portrayed in the
movies?A. First of all, in most films, a distinction is not made
between serious mental illness and schizophrenia. It's only in
recent years that schizophrenia itself has been defined in any way
approaching reality.

Out of over 400 films depicting psychiatric treatment, I can
think of less than five that I would call accurate. One was "I Never
Promised You a Rose Garden," based on Hannah Greenberg's book. And
one other film that was fairly accurate was "Benny and Joon."

But inaccuracy goes back as far as 1909 to a D. W. Griffith film
called "The Maniac Cook." In this film, a cook becomes distressed
and starts attacking her employers and is led away by the police.
She escapes and first plans to kill her employers in their bed with
a kitchen knife, but instead kidnaps the baby and puts it in the
oven to roast.Q. Violence is often linked with schizophrenia on
the screen, is it not?A. Yes, this stereotype of the homicidal
maniac has been one of the primary myths perpetrated by the cinema
about the seriously mentally ill. A more modern version of this can
be seen in films like the "Halloween" series, where the Michael
Myers character is the Devil himself.

Another stereotype has been to portray schizophrenia inaccurately
as split personality. In "Me, Myself and Irene," the recent Jim
Carrey film, you saw that. But probably the classic film of this ilk
would be "Psycho." In what appears to be a severely psychotic
individual, we see Norman Bates taking on the personality of his
mother and dressing like her and becoming a killer of women who
arouse him sexually.

And then, of course, there is Brian De Palma's 1980 film,
"Dressed to Kill," which has a similar theme.

Yet another stereotype grows out of the R. D. Laing and Thomas
Szasz idea that mental illness either does not exist or is an
enlightened expression of rebellion against a crazy society. An
example of this would be "A Fine Madness," in which Sean Connery
plays a poet with writer's block, and he is shown as a free spirit
who is fighting alone against the psychiatric establishment.

The other classic film of this type is "King of Hearts," a French
film, in which Alan Bates plays a Scottish soldier sent on a mission
to disarm a bomb in a small French town. All the townspeople except
the patients in the local mental hospital have been evacuated. And
the patients take over the town and show themselves as a fun-loving
group capable of creating a utopian society.

One other stereotype I might mention I've called the zoo
specimen. You see this in films like "Snake Pit" and "Marat Sade,"
the 1966 film based on the play. In "Snake Pit," for example, Olivia
de Havilland is hospitalized and comments on the similarity between
the patients on the wards and animals in their cages in a zoo.Q.
What makes "A Beautiful Mind" noteworthy in its approach to mental
illness?A. Overall, it's one of the better portrayals, if not
the best, of what the disease is like.

As the title implies, it shows that someone with schizophrenia
can be capable of having a beautiful mind — in the sense of making
significant contributions in an academic field, having loving
relationships, helping students.

One of the things I liked about the film was that they showed
that in the long term, some people can actually return to
functioning despite the illness, that they can learn to manage it in
the same way a diabetic learns to manage diabetes. The other thing
is that they portrayed the kind of chronic struggle that both the
patient and the family goes through around complying with
medication, and around trying to adjust to the psychotic thinking by
ignoring it and recognizing it as not real. That was nicely
depicted.

Also, it portrays medication as effective and useful. To put this
in context, when we wrote "Psychiatry and the Cinema," we could only
find one film that really showed the effectiveness of psychiatric
medication, and that was "As Good as It Gets." But one reading of
that film would be that it was the love of Helen Hunt rather than
the medication that cured Jack Nicholson.

In "A Beautiful Mind," it's clear that when he does take
medication he gets better, and when he's cheeking it and hiding it
he doesn't.Q. Are there ways in which the portrait of
schizophrenia in "A Beautiful Mind" departs from realism?A. The
major departure would be the emphasis on visual hallucinations. The
vast majority of hallucinations in schizophrenia are auditory, that
is, hearing voices. On the other hand, the cinematic medium demands
visual representations of the inner world. In a novel, you can have
a first- person narrator describe in detail what's going on in his
mind. But in the movies, there has to be some way of visually
representing a delusional world.Q. Doesn't the film romanticize
mental illness, for instance in associating genius with
schizophrenia?A. Of course it romanticizes mental illness.

The job of a filmmaker is to fill the seats at the theater. So
the entire arc of John Nash's life and marriage is all
romanticized.

The idea that madness and genius are very closely related is also
a recurring theme in Hollywood cinema. We can think of recent
examples like "Pollock," and most films about musicians, like Mozart
in "Amadeus," will show a connection between genius and madness.

But the research suggests that there is probably a much closer
relationship between genius or extraordinary talent and manic
depressive illness than schizophrenia. Schizophrenia causes such a
global deterioration that works of genius would be very difficult to
sustain.

Even when a person is successfully treated with medication and
various kinds of therapy there is usually a continued deficit in
functioning. And you can see that pretty well portrayed near the end
of "A Beautiful Mind." We're not led to believe that Nash has been
completely restored to his previous level of functioning.Q. Do
the images of mental illness in the movies arise from misconceptions
that already exist in the culture, or vice versa?A. Well, let's
look at things historically. There were times when mental hospitals
in the United States charged admission so the public could gawk at
the mentally ill. So we have this tradition of looking at the
mentally ill as strange, exotic and totally different than Me. And
the movies, to some degree, appropriate a pre-existing stigma that
was rampant in the society.

But there's another aspect we ought to bring up. The Hollywood
cinema operates on cultural mythology. In fact, I would say that
just as the ancient Athenians went to the theater and got their
sense of what it means to be human from Sophocles, contemporary
citizens in the United States learn what it means to be human from
the movies. So that both the Greek dramas and modern American movies
are mythopoetic in that sense.

One of the things we see in movies about psychiatry or mental
illness is a mythic narrative that audiences want to see rather than
a mirror held up to reality. And we really can't expect Hollywood to
give us the stark reality that we see in psychiatric hospitals or
psychiatric outpatient clinics.

For example, in the movie, John Nash looks like Russell Crowe,
Mrs. Nash looks like Jennifer Connelly. He gives a stirring speech
at the Nobel Prize ceremony that he never really gave. The
homosexual relationships he had in real life and his divorce are
also excluded from the movie.Q. Do you think that people who see
"A Beautiful Mind" will start to think differently about mental
illness?A. I think there is an educational benefit. It shows
that someone with schizophrenia can be very intelligent, can retain
a sense of humor and can persevere with this illness. And it does
educate the public that this can strike anybody, and even people who
are talented and gifted.

The fact that Russell Crowe is playing the character with
schizophrenia is also very significant. Russell Crowe is becoming
the John Wayne of our era. Here's a guy who just won the Oscar for
playing in "Gladiator." If this masculine, sexy movie star can be
connected in people's minds with serious mental illness, then there
is a certain cachet. We live in a celebrity-mad culture. And the
association of something with celebrity has tremendous
influence.